Medicare and Home Care

One of the most common questions asked by Help At Home callers is whether or not Medicare covers the services that we offer. The plain and simple answer is, "No." Beware of private home care agencies that "insinuate" that they do. We certainly have skilled nursing agencies available that are certified, skilled and Medicare certified. But the simple fact is that Medicare is not in place to provide respite care for family caregivers, homemaking or two to twenty-four hours of care a day.

The following is a general overview of what Medicare covers (currently) in terms of home health care. Care must be temporary and part-time, and you must meet these requirements:

• Your doctor must say that you need the care. Your doctor must document that you need care at home and make a plan for that care.

• You must need skilled care or therapy (physical, speech or occupational).

• You must be homebound. Homebound means that leaving home is a major effort and you cannot do it without help. When you do leave home, it must be to get medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care.

• The home health agency must be Medicare-approved.

• If you meet all the requirements for home health care, Medicare will pay for:

• Occasional skilled nursing care: This is care that can only be done safely and correctly by a licensed nurse. That's either a registered nurse or a licensed practical nurse.

• Physical therapy: Physical therapy includes exercise to regain movement and strength to part of your body, and training on how to use special equipment to take care of yourself.

• Occupational therapy: Occupational therapy helps you do daily activities by yourself, such as eating, putting on your clothes or combing your hair.

• Speech-language therapy: Speech-language therapy is exercise to help you speak more easily and clearly.

• Medical social services: These services can help you with social and emotional concerns related to your illness. For example, you might need counseling or help finding resources in your community.

• Some medical supplies such as wound dressings, but not prescription drugs.

• Some medical equipment such as a walker or a wheelchair.

Medicare might pay for personal care like bathing, help using the toilet or help with dressing if you are also receiving skilled care such as nursing care or other therapy.

BUT Keep in mind that many people need long-term care simply as a result of the frailty that comes about simply because of aging. Medicare doesn't cover this type of need and you'll pay out-of-pocket or have insurance to cover qualifying circumstances. Medicare also does not pay for 24-hour-a-day home care, prescription drugs, meals delivered to your home or homemaker services such as cleaning, laundry and shopping.

Typically, when Medicare does cover home care you do not have to pay for anything except 20 percent on certain kinds of durable medical at equipment. There is no time limit on home health care as long as you continue to meet the require me
So, really, people should be looking realistically at not only their monetary resources, their social resources (family and friends that really care and would help you, the resources in the community that you plan on living in and be realistic about your life plan.

Learning more about long-term care insurance as an option to pay for home care costs is worthwhile - visit the Consumer Information Center of the American Association. There is a wealth of information and you can access the Associations comprehensive online directory of over 3,000 insurance professionals who can assist with your long-term care insurance needs.

Call my care managers or myself for information and complimentary consultations at Help At Home, www.helpathome.us, 877-622-9020.